心肺功能测定与冠心病的诊断和预后评价_王宁夫.ppt

心肺功能测定与冠心病的诊断和预后评价 南京医科大学附属杭州医院心内科 王宁夫 Detection of exercise induced ischaemia:a new role for CEPT The prognostic and diagnostic value of the exercise test is maximized, when multiple exercise findings are considered and it seems, that respiratory gas analysis offers new perspectives in this sense. Cardiologists should realise that with CPET we have an enormously powerful tool to our disposal. European Heart Journal 2003 Volume 24, Number 14 EditorialThe predictive value of cardiorespiratory fitness Franz X. Kleber* Charité Medical School, Ukb Academic Teaching Hospital, Berlin, Germany, EHJ 2004 25: 1428-1437. [Abstract] [Full Text]  Furthermore, peak oxygen consumption is a more accurate and reproducible measure and has been shown to be an excellent predictor of outcome in various diseases. Recently, large scale investigations of exercise capacity derived from peak cardiorespiratory exercise data have been used to study the relationship between VO2max and risk of cardiac and all cause death and in heart failure cardiopulmonary exercise test results have been established as outstanding prognostic information. 心肺运动试验(CPET)定义 慢性心力衰竭心预后的评估 目前最常用的是Weber-Janicki 分级 Peak oxygen pulse during exercise as a predictor for coronary heart disease and all cause death Heart 2006;92:1219-1224  VO2分层及预后的评估 预后的评估 整个队列随访信息完成了98.3%，在平均四年的随访过程中，187 病人死亡(29%) ，101进行了心脏移植，精确的1和5年生存率分别为90.5% 和 73.4%， 运动峰值氧耗量(VO2)是独立的危险因子，比达到的运动功率和其他运动和临床变量价值更大， 生存率近20%的差别主要在于10 ~17 mL/kg/min范围外，在范围之外生存率变化具有差别(P .01)，之间的数值其意义是相似的。 慢性心力衰竭心预后的评估 结果： 心肺运动试验(峰值氧耗量）15.2±4.5ml/kg/min， VE/VCO2：38.7 ±11.8， 核素左心室造影LVEF32.8±14.3%； 心脏超声 (LVDV 6.1±1.1) cm, LVSD( 4.7 ±1.5)cm. 随访结束时, 26病人死亡.生存者中位随访时间为 47.7 月 (31.5–53.5月). 第一年死亡率：18% 第二年死亡率：29%. 评价冠心病介入治疗的效果 Klainman等在成功施行PTCA的冠心病病人，术后即进行心肺运动试验 结果显示：氧摄取量，氧脉搏，氧脉搏积分，无氧阈显著改善，但最大心率没有明显变化. 心肺运动试验是冠心病PTCA术后功能评价的一种有效的方 法。 The effects of PTCA on the peakVo2, and the maximal work rate The effects of PTCA on the time constant of Vo2, the gas-ex